Clinical Assessment and Management in Improving the Quality of Life of HIV/AIDS Patients with Oral Candidiasis: A Case Series

Figures & data

Figure 1 Intraoral appearance of the patient in Case 1 (A–E) There were “cottage cheese-like” lesions involving the entire oral cavity on the first visit (F–J) After two weeks, the lesions healed.

Table 1 Serological Examination Result

Test	Case 1	Case 2	Case 3	Case 4	Case 5	Reference Value	Unit
Hemoglobin	11.1 ^L	9.0 ^L	12.9 ^L	11.1 ^L	14.4 ^N	14–17.4	g/dL
Hematocrit	34.0 ^L	27.7 ^L	38.4 ^L	33.3 ^L	40.3 ^L	41.5–50.4	%
Erythrocytes	3.82 ^L	3.07 ^L	4.26 ^L	3.78 ^L	4.66 ^N	4.5–5.9	10^6/µL
Leucocytes	15.64 ^H	15.67 ^L	7.10 ^N	3.83 ^L	2.25 ^L	4.4–11.3	10^3/µL
Thrombocytes	394 ^N	288 ^N	295 ^N	66 ^L	238 ^N	150–450	10^3/µL
Basophil	0 ^N	0 ^N	0 ^N	0 ^N	0 ^N	0–1	%
Eosinophil	35 ^H	34 ^H	6 ^H	0 ^N	4 ^N	0–4	%
Neutrophil bands	1 ^L	0 ^N	1 ^L	4 ^N	4 ^N	3–5	%
Neutrophil segmented	35 ^L	31 ^L	64 ^N	46 ^N	22 ^L	45–73	%
Lymphocytes	21 ^N	29 ^N	17 ^L	35 ^N	52 ^H	18–44	%
Monocytes	8 ^N	6 ^N	12 ^H	15 ^H	18 ^H	3–8	%
Total Neutrophil	5.63 ^N	4.86 ^N	4.62 ^N	1.92 ^N	0.59 ^L	1.31–6.71	10^3/µL
Total Lymphocytes	3.28 ^H	4.54 ^H	1.21 ^N	1.34 ^N	1.17 ^N	0.9–3.22	10^3/µL
Total Monocytes	1.25 ^H	0.94 ^H	0.85 ^H	0.57 ^N	0.41 ^N	0.12–0.62	10^3/µL
Total Eosinophil	5.47 ^H	5.33 ^H	0.43 ^H	0.00 ^N	0.09 ^N	0.00–0.30	10^3/µL
Total Basophil	0.00 ^L	0.00 ^L	0.00 ^L	0.00 ^L	0.00 ^L	0.01–0.09	10^3/µL
MCV	89.0 ^N	90.2 ^N	90.1 ^N	88.1 ^N	86.5 ^N	80–96	fL
MCH	29.1 ^N	29.3 ^N	30.3 ^N	29.4 ^N	30.9 ^N	27.5–33.2	Pg
MCHC	32.6 ^L	32.5 ^L	33.6 ^N	33.3 ^L	35.7 ^H	33.4–35.5	%
Glucose	76 ^N	57 ^N	80 ^N	74 ^N		<140	mg/dL
Urea	19.3 ^N	18.2 ^N	36.3 ^N	9.7 ^L	6.6 ^L	19–44	mg/dL
Creatinine	0.9 ^N	1.64 ^H	1.36 ^H	0.78 ^N	0.85 ^N	0.72–1.25	mEq/L
Sodium (Na)	143 ^N	149 ^H	4.6 ^N			135–145	mEq/L
Potassium (K)	4.3 ^N	3.9 ^N	139 ^N			3.5–5.1	mEq/L
Chloride (Cl)	111 ^H	125 ^HH	4.1 ^N			98–109	mEq/L
AST	26 ^N	94 ^H	14 ^L	28 ^N	104 ^H	15–37	U/L
ALT	32 ^N	22 ^N	7 ^N	11 ^N	78 ^H	0–55	U/L
Anti-HIV	R	R	R	R	R	NR
Anti-CMV IgG			176.3 ^R			NR: <6.0	AU/mL
Anti-CMV IgM			0.1 ^NR			NR: <0.85	index

Abbreviations: H, high; HH, very high; N, normal; L, low; R, reactive; NR, non-reactive; MCH, Mean corpuscular hemoglobin; MCHC, Mean corpuscular hemoglobin concentration; MCV, Mean corpuscular volume; AST, Aspartate aminotransferase; ALT, Alanine aminotransferase; HIV, Human Immunodeficiency virus; CMV, Cytomegalovirus.

Figure 2 Clinical features of the patient in Case 2 (A–E) On the first visit, white spots on the dorsal tongue and erythematous areas (F–J) The lesions have improved after one month.

Figure 3 Clinical presentation of the patient Case 3 (A and B) On the first visit, the thrush was present as yellowish-white plaques on the tongue (C) A single ulcer on the buccal mucosa (D and E) A painful, primary, single ulcer on the oropharynx (F–J) The lesions had entirely resolved after four weeks.

Figure 4 Intraoral lesions in patient Case 4 (A, B, D and E) On the first visit, there were extensive white plaques on the palate and tongue (C) A painful single ulcer with an irregular, yellowish base on the right lateral tongue (F–J) After one month, the lesions recovered.

Figure 5 Intraoral condition in patient Case 5 (A–D) On the first visit, white plaques resembling curdled milk were present on the labial mucosa and buccal mucosa (E) Diffuse erythema of the hard palate (F–J) After four weeks, the lesions disappeared.

Table 2 A Brief Comparison of Five Cases

	Case 1	Case 2	Case 3	Case 4	Case 5
Gender	Male	Male	Male	Male	Male
Age	32 years	48 years	71 years	32 years	38 years
WHO clinical stage	IV	IV	IV	IV	IV
Duration of HIV diagnosis	12 years ago	2 years ago	3 days ago	1 month ago	3 weeks ago
ART	Dropped out for 1.5 years	Dropped out for 1.5 months	Not yet received	Not yet received	Not yet received
CD4+ count; TLC	CD4= <40 cells/mm^3	CD4= 39.3 cells/mm^3	TLC= 1210 cells/µL	TLC= 1340 cells/µL	TLC= 1170 cells/µL
Viral load	<40 copies/mL	<40 copies/mL	<40 copies/mL	–	<40 copies/mL
BMI before treatment	19.8 (Normal)	18.8 (Normal)	17.6 (Underweight)	18.4 (Underweight)	21.2 (Normal)
BMI after treatment	21.3 (Normal)	22.9 (Normal)	18.4 (Underweight)	20.3 (Normal)	23.7 (Normal)
OHI-S score	3.2 (poor)	3.0 (fair)	4.3 (poor)	3.1 (poor)	2.8 (fair)
OHIP-14 score before treatment	18 (good)	6 (good)	20 (moderate)	20 (moderate)	18 (good)
OHIP-14 score after treatment	0 (good)	0 (good)	3 (good)	0 (good)	0 (good)
Oral candidiasis description	Yellowish-white plaques in the oral cavity, which are easily removed mechanically A painful, reddish fissures on both corners of the lip	Reddish patches on the palate, mucosa, and dorsal tongue White spots that could be scraped off, leaving areas of erythema on the dorsal tongue A painful, reddish fissures on both corners of the lip	White spots that could be scraped off, leaving areas of erythema on the dorsal tongue	White plaques that could be scraped off, leaving areas of erythema on the mouth	White plaques that could be scraped off, leaving areas of erythema on the mouth An erythematous area on the median palate.
Diagnosis	Pseudomembranous candidiasis, angular cheilitis, oral hairy leukoplakia	Pseudomembranous candidiasis, erythematous candidiasis, angular cheilitis, fissured tongue	Pseudomembranous candidiasis, cytomegalovirus-associated ulceration, exfoliative cheilitis	Pseudomembranous candidiasis, suspect tuberculous ulcer on right lateral tongue and left buccal mucosa, exfoliative cheilitis.	Pseudomembranous candidiasis, erythematous candidiasis, exfoliative cheilitis, oral hairy leukoplakia
Predisposing factors	Poor oral hygiene, drinking alcohol	Smoking	Poor oral hygiene, smoking, drinking alcohol	Poor oral hygiene, TBC, smoking	Smoking
Prognosis	Good	Good	Good	Good	Good
Medical treatment	Tenofovir lamivudine dolutegravir	Tenofovir lamivudine dolutegravir	Tenofovir lamivudine dolutegravir	Tenofovir lamivudine dolutegravir	Tenofovir lamivudine dolutegravir
Dental treatment	Fluconazole, 2% miconazole cream, 0.2% chlorhexidine gluconate, and multivitamin.	Fluconazole, 2% miconazole cream, 0.12% chlorhexidine digluconate, and multivitamin.	Fluconazole, 0.2% chlorhexidine gluconate, diphenhydramine, petroleum jelly, and multivitamin.	Fluconazole, 0.2% chlorhexidine gluconate, and multivitamin.	Fluconazole, 0.2% chlorhexidine gluconate, petroleum jelly, and multivitamin.
Follow up	Lesions healed after 2 weeks	Lesions healed after 4 weeks	Lesions healed after 4 weeks	Lesions healed after 4 weeks	Lesions healed after 4 weeks

Abbreviations: WHO, World Health Organization; HIV, Human Immunodeficiency Virus; TLC, Total Leucocyte Count; ART, Antiretroviral Therapy; BMI, Body Mass Index; OHI-S, Oral Hygiene Index Simplified; OHIP-14, Oral Health Impact Profile-14.